The effect of brain tumour laterality on anxiety levels among neurosurgical patients.(Paper)

Objectives: The aim of this study was to investigate the level of anxiety in patients with a primary, brain tumour and to analyse the effect of tumour laterality and histology on the level of anxiety. Recurrent measurements were assessed preoperatively, three months, and one year after operation.

Methods: The study population consisted of 101 patients with a primary brain tumour from unselected and homogeneous population in northern Finland. The patients were studied preoperatively with CT or MRI to determine the location of the tumour. The histology of the tumour was defined according to WHO classification. The level of anxiety was obtained by Crown-Crisp Experiential Index (CCEI) scale.

Results: The patients with a tumour in the right hemisphere had statistically significantly higher mean anxiety scores compared to the patients with a tumour in the left hemisphere before surgery of the tumour. By three months and by one year after surgical resection of the tumour, the level of anxiety declined in patients with a tumour in the right hemisphere. A corresponding decline was not found in patients with a tumour in the left hemisphere. According to laterality by tumour histology, the level of anxiety decreased significantly in male and female patients with a glioma in the right hemisphere, but a corresponding decline was not significant in the female patients with a meningioma in the right hemisphere. Decreased level of anxiety was not found in patients with gliomas or meningiomas in the left hemisphere by follow up measurements.

Conclusions: Primary brain tumour in right hemisphere is associated with anxiety symptoms. The laterality of anxiety seems to reflect the differentiation of the two hemispheres. The level of anxiety declined after operation of right tumour, approaching that of the general population. The effect of right hemisphere gliomas on anxiety symptoms deserves special attention in future research.

Several studies have focused on hemispheric lateralisation in neuropsychiatric disorders. (1 2) Left brain damage has been found to be associated with depressive affective states, (1 3-5) while apathy (6) and mania (1) have been associated with right brain damage. Anxiety as a symptom of brain damage has not been as thoroughly studied as other psychiatric disorders, (1) but there is evidence of right cortical disturbance in patients with panic anxiety. (7) Several case reports have described relationships between focal right sided brain lesions and anxiety or panic. (8-11) By using a neurological stroke patient sample (n = 309), Castillo et al (12) suggested that anxiety combined with depression was associated with left cortical lesions, whereas anxiety alone was associated with right hemisphere lesions. Another study of healthy university students without any brain damage showed that depression and anxiety may be associated with opposing biases in perceptual asymmetry scores defined by neuropsychological tests; depression with left sided and anxiety with right sided. (13) There have also been opposite findings, but these are based on case reports or small databases. (14 15)

Only a few studies have been done on psychiatric symptoms in patients with a primary brain tumour, and most of our knowledge is a result of individual case reports and case series. (8-11 15) However, there are two studies with a sophisticated study design and unbiased study sample suggesting a link between neuropsychiatric symptoms and tumour location. (16 17) Pringle et al (16) studied patients (n = 109) with solitary intracranial neoplasms and anxiety and depression before and after surgery, compared with control population. They found that before the operation 30% of patients were probably anxious, 19% were possibly anxious, and 51% had scores suggesting no significant anxiety measured by Hospital Anxiety and Depression Scale (HAD). In preoperative assessments, female patients with a left sided tumour had higher levels of anxiety than males. One week after the resection of the tumour there were significant reductions in levels of anxiety in both males and females, and the reduction was not affected by hemispheric laterality. Patients with meningioma obtained higher scores of anxiety than groups with other types of brain tumour. However, because the anxiety measurements were performed only during a one week period before and after operation, the finding may reflect acute stress reaction rather than anxiety itself.

In a study performed by Irle et al (17) the brain tumour patients (n = 141) with right posterior lesions reported significantly increased levels of anxiety and depression postoperatively compared with patients with right anterior as well as …